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Female Condom Research Briefs Series — No. 6:Female Condom Introduction in South Africa |
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South Africa is one of the few countries in the world where a national family planning program has played a central role in introducing female condoms. The female condom was first introduced in 1998 through family planning clinics and community-based programs to broaden its acceptance and avoid stigmatizing it as being purely for disease prevention. Since then, through gradual expansion to more than 200 sites, South Africa's female condom program has become one of the largest in the world. Piloted through family planning clinics The South African Department of Health's National Expanding Dual Protection Strategies Programme was designed and implemented by the Reproductive Health Research Unit (RHRU) of the University of Witwatersrand, with technical assistance from FHI. The program was implemented to increase options for protection against unintended pregnancy and sexually transmitted infections (STIs), including HIV. Available data over the first 18 months of the project suggest several important trends. These findings come from 9,406 initial acceptors at clinics, with 1,725 re-supply visits, and from 1,381 initial acceptors at PPASA sites, with 300 resupply visits.
Sustained use Interviews were conducted with 198 women in four provinces in February and March 2000. The women were randomly selected from among those who were supplied with the device at least once. Many of the women continued using the device beyond initial experimentation. Forty-three percent reported continued female condom use, and one-third reported using it more than 10 times. A small minority of respondents reported problems sometimes associated with the device, such as difficulty with insertion, noise during intercourse and slippage. Partner objection was the main reason for abandoning female condom use. Female condoms served to complement — rather than replace — male condoms. Forty-four percent of current female condom users also reported using male condoms. Many women reported that the female condom empowered them to protect themselves, primarily because the method could be used in situations in which they could not persuade a man to use a male condom. About nine of every 10 women interviewed said that they used protection more often since having the female condom available; however, when asked to explain, they referred more frequently to the safety and coverage provided by the female condom than to additional sex acts protected. Interviews were also conducted with 18 providers in these four provinces. All felt the female condom was a necessary addition to the program, serving as an additional choice for women who have trouble using male condoms or other family planning methods. Most saw female condom promotion as an integral part of their job as opposed to an added burden. Half of the providers believed that female condoms were more effective than male condoms in preventing pregnancy and STIs because they are made of stronger material than male condoms and protect a woman's external genitalia. They also thought female condoms could not be tampered with by men and were more likely to be used properly. Providers reported that some women initially had a negative reaction to the device's appearance, while others needed help in talking to their partners about using protection. Providers requested more information to help answer women's questions and reassure them. Interviews revealed that provincial coordinators' support was an important element of successful female condom distribution. These interviews, plus site visits in other provinces, revealed barriers to integrating the female condom into clinic activities. Some providers said they lacked time to counsel clients about dual protection and explain proper female condom use. Some said it was too complicated or awkward to use and did not offer it to clients. When the provider responsible for female condom services was away on leave, distribution was sometimes suspended. Inadequate inventory management and shipping delays led to unpredictable supplies, which discouraged providers and clients from embracing the method. Expanding the program The pilot introduction indicated that South Africans used the female condom, and both family planning providers and clients supported sustained distribution of the method. Findings from this pilot phase informed expansion of female condom distribution beyond family planning service delivery points to reach individuals at elevated risk of STI transmission, such as men in the workplace, adolescents, sex workers and people living with HIV/AIDS. By 2005 the Department of Health had expanded the program to 204 rural and urban sites, including non-clinical sites such as truck stops, brothels and universities. South Africa's program is second only to Brazil's in number of female condoms distributed. In 2005 the Department of Health procured 2.4 million female condoms, up from 1.2 million to 1.3 million in previous years. That year the RHRU trained an additional 90 master trainers and 902 health care providers to begin further expansion of the female condom program to a total of 249 sites. The program's strengths include its national leadership, structured introduction strategy, well-monitored and controlled supply of female condoms, and comprehensive training of providers on female condoms and dual protection. Challenges it faces include keeping pace with demand and program costs and stimulating greater private-sector involvement in female condom distribution and promotion.2 Endnotes
FHI produced these research briefs as part of an information dissemination effort supported by the Bureau for Africa/Office of Sustainable Development, U.S. Agency for International Development. |
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